What A Sustainable Health Care System In The U.S. Might Look Like

I don't know about "life balance". They never taught me psychobabble in school.

But I do know about "happiness". I had fun in school as a kid.. doing well with academics and playing sports, surrounded by great friends. And my family was great... a dad that always had time for me. When other dads on Saturday mornings were too busy, my dad was coaching my team, from baseball to football to basketball. I really sucked at basketball and had to give it up... I ended up a state champion wrestler in high school... champion n debate too... GREAT FUN! I always kept my ete on the ball, striving to do my best. It worked, My dad had some great ideas. As long as I got great grades and did well in sports, I'd get date money and the fdamily car keys on the weekend! WHAT A PLAN! Is that what you mean by "balance"?

Joining the Army I had even more fun! A young Soldier in DC! (I saw Neil Diamond at the "Upstairs Downstairs" in Georgetown!) and continued to work hard on academics and sports to get into West Point... which I did... too many great experiences there to address! Then off to Command of a Basic Training Company at Ft Leonard Wood ... where I was given the opportunity to help so many folks start great new lives! Get an MBA along the way!... then off to Germany to Command an Artillery Batter learning all sorts of stuff about things from nukes to Europe, from great people to governmental operations. The more years in the Army immersed in high tech, travel, weapons, and so many exciting things. Then transition into civilian industry, traveling the world looking to identify things soldiers need and want then returning home to lead engineering teams in designing and building them. A sabbatical to train the NEW Iraqi Army for a year and a second year on staff with American civilian firefighters in Iraq. Oh... and I forgot a couple of years as a high school Physics teacher in California. Great fun and very rewarding... especially with one young gal who told me "You'[re the first adult who ever said I was worth a damn". Loads of fun and very rewarding. Along the way I ended up with a son who's a Cornell and Fordham Law grad, a wife who's a great mom, loving wife, as well as a lawyer and CPA.

Now retired in a wonderful place I often compare to the peaceful place Beaver Cleaver grew up, I spend my days gunsmithing, puttering around the house, and playing with cats. Recently SUPERWIFE and I have been talking about going sailing again. We've sailed the Caribbean, Alaska, and Europe. It might be fun to sail to Alaska.

What were you saying about "Life Balance"????

 

Everybody has those sayings. You must remember that human nature is not about sayings, but instead, actions. Ideally, it would be nice if everything was "fair," but the problem with the concept of fairness is the same as the concept of all ideals, they differ from person to person, group to group.

You want to set up a system that operates on the principals of efficacy and sustainability. That's about as fair as you can get. Then allow individuals the freedom to administer what only individuals can...compassion.

 

That goes without saying, but you are dealing with the human world where the best you can do is set up systems that are efficacious and sustainable. That's about as fair as you can get.

It really doesn't. Our system is so bad that it makes less bad seem good [when they are not so great themselves]. All these systems are perpetuating/rewarding poor health habits. It would be like having national auto insurance and giving everybody a new ICE because they were too lazy to ever get their oil changed. Bad policy...unsustainable.

Only indirectly. People need to do for themselves, otherwise you create dependency and dys-function.

Charity is better than government programs. It will require that people do all they can for themselves before seeking help. It will also serve as impetus to keep families and communities together.

And yes, tragedy is a large part of life. Learning how to deal with it determines your level of functionality.

RIch people get more of everything...so do highly intelligent people, better looking people, and the same applies to people with all kinds of high level skills...as does it to those who are born with better health prospects.

Would you like to level the playing field when it comes to all things that make us different? Then what is your plan to penalize all the people who are born with all these attributes?

Did you have to work hard for your degrees or did somebody feel sorry for you and hand them to you, "just because?" There is no free lunch.

 

Congratulations for living what you feel is a perfect life, but this is the sort of thing that is apparently causing young women to suffer tremendous anxiety and depression, that is, other people posting their fictitious lives on line and then worrying about how horrible their life is in comparison.

Again, I congratulate you on all your wonderful achievements, but you have seemingly left out all the not great things that happens to us all as with go through life. After all, life is full of difficulty and tragedy, as well. And it is these things which demand that we grow. Nobody learns a great deal from success.

Achieving a life balance simply refers to the idea that you have gained the skills to gracefully deal with the good and the bad that inevitably comes to every person.

After all, even "The Beve" had his issues.

 

This is no fictitious life. And its quite common. My fiftieth West Point reunion is coming up. My life since graduation will be quite average among that group. I am looking forward to spending some time with happy, successful people and escaping the whining, complaining society we have become. By the way, women have been attending West Point since the 1970's, so many of the attendees will be happy, successful women.

Responsible, motivated people make their own success and happiness, They achieve on their own without reliance on handouts. Everyone has problems along the way. Some choose to whine and complain about the problems... others choose to deal with bumps in the road and stay focused on happiness and achievement, both personal and professional.

 

Good luck!

 

Luck enters into it somewhat, but its much more about personal responsibility and motivation.

 

Good personal responsibility and motivation.

 

It's worth nothing since you have no understanding of how your current system evolved and came to be.

Nope. Wrong answer.

The insurance companies did not write the Obamacare legislation, but the American Hospital Association did.

The insurance companies did not write the Medicare legislation, but the American Hospital Association did.

The insurance companies did not lobby Congress to kill the golden goose that would allow Americans to profit off of their own healthcare, and even better, Americans would only have to pay monthly premiums for 10 years (or a lower premium for 20 years or an even lower premium for 30 years) he Obamacare legislation, but the American Hospital Association did.

The insurance companies did not create the silly stupid "Out-of-Network" policy, but the American Hospital Association did.

The insurance companies did not lobby State legislatures to exempt hospitals from anti-trust actions so's they could operate as monopolies, but the American Hospital Association did.

The insurance companies did not lobby State legislatures to prohibit you from purchasing $125,000 in annual ER coverage (costing about $4.50/month) or prohibit you from purchasing catastrophic coverage, or prohibit you from purchasing your coverage a la carte (meaning you buy only what you need or want), but the American Hospital Association did.

When you repeal all the federal and State statutes bought and paid for by the American Hospital Association, then you will no longer have a Socialist Soviet-style Command Market System. You'll have a Capitalist Free Market System and it will be affordable for everyone.

Did you just wake up from a 100 year slumber?

Individuals are already in charge of their own healthcare. They can choose to live healthy lives or not. And if they become ill, they participate in their treatment plan.

Why not? In a Capitalist Free Market System you would prohibit someone from paying $32/month for a $1 Million catastrophic care policy?

And they'd only have to pay $32/month for 10 years. And they would still be covered until they died. They could pay less than $32/month for 20 years if $32/month was an incredible hardship.

Not only have you contradicted yourself, you've made it impossible to believe you're a physician.

Yes, it's true that 65% of the cost of medical care is driven by technology.

It's also true that the cost of medical care dictates in part the cost of health plan coverage. Right? Your auto insurance does not dictate what you pay for your car anymore than your homeowner's insurance dictates the price you paid for your home.

Technology is absolutely necessary in many instances to correctly diagnose disease or illness. It's also needed to determine the extent of physical injuries.

It's shocking that you claim to be a physician but don't understand that.

What's best for them is to use the technology you reject and get the MRI that they can't afford.

Do you have any idea how many freaking doctors wasted my time before one finally said, "Hey, you need an MRI."

The MRI discovered bone chips at C8/T1 'cause we crashed and burned in the Harz Mountains. Well, we were on fire and then we crash and burned and I bounced off the troop seat and landed on the floor of the Chinook and then it broke apart and burned. I still have a piece of the Chinook that melted onto by BDU pants.

I had to take pills for years for that and then I had an MRI and a simple surgery and I'm all better and no pills.

Having said that, the two main policy points of the American Medical Association (whom I respect) have been that doctors are free and independent and patients should be charged sliding scale fees (obviously income-based.)

The American Hospital Association is diametrically and diabolically opposed to that. Their two points are all doctors are hospital employees and controlled by hospitals and all patients pay the same. The AHA's position will get people killed.

The AMA's position is the morally and ethically superior one, but really, denying people technology because no one can afford is pretty stupid.

Well, you see, in a Capitalist Free Market System insurers would not be forced to use the Community Rating Scheme that the American Hospital Association lobbied State legislatures to enforce.

Under the Community Rating Scheme, which has existed since 1954 and thus no American has had health insurance since 1954, single people get super ripped-off to subsidize the cost of the marrieds with children and the elderly, and the marrieds without children get ripped-off to subsidize the cost of the marrieds with children and the elderly.

That's quite socialist, since it is a "redistribution of wealth" (actually it's a redistribution of income.)

Auto insurance premiums are based in part on driving record so most people do make an effort to comply with driving laws to avoid higher premiums.

If we truly had health insurance instead of the fee-for-service we've had since 1954, then people have some skin in the game and they become more health conscious if for no reason than to avoid high premiums.

 

You sound exactly like the idiots who scream, "We wanna system like Europe!"

The US has hospital monopolies and monopolistic hospital cartels; Europe does not.

The US continues to use the antiquated outdated outmoded obsolete Hospital Model; Europe does not, because they use the Clinic and Policlinic Models.

Monopolies create redundancy and there is redundancy-a-plenty in the US which drives up the cost of medical care; Europe has no redundancy and so costs are lower.

We can look at a real world example. The Cincinnati Metropolitan Statistical Area is 11 counties in 3 States with a population of 11 Million and there are 17 hospitals and 15 perform open-heart surgery. They are required to do so because they are members of the American Hospital Association which dictates what services member-hospitals must provide.

Berlin, Germany. It's a city-State with a population of 8 Million people but there are only 3 cardio-pulmonary centers that perform open-heart surgery.

11 Million people: 15 hospitals performing open-heart surgery
8 Million people: 3 clinics performing open-heart surgery

See the difference?

Germany, France, Romania, Italy, Austria, Poland they all reduce costs by controlling the amount of technology.

That does mean people have to travel to get their healthcare needs met.

You live in Garlstedt in Kreis Osterholz. Krieskrankenhaus Osterholz (a rural county hospital) does not have a cardio-pulmonary clinic. You'll have to drive 60 miles north to Bremerhaven or 45 miles south to Bremen to go to a cardio-pulmonary clinic.

If you want/need open-heart surgery, you'll have to make the 4 hour drive to Hamburg.

If we had a Capitalist Free Market healthcare system, Cincinnati would not have 15 hospitals performing open-heart surgery. The Free Market would cut that down to about 3 and it would also lower the cost.

If you tried to overlay a universal healthcare system onto the nightmare your State and federal governments and the American Hospital Association created for you, all you're doing is putting lipstick on a pig and it will cost you more than what you're paying now.

 

I like the US healthcare system. In 2014 I had triple bypass. My employer's insurance covered it all. I never paid any premiums, my coverage was part of my compensation... like salary and vacation. At the time I also got a pacemaker. The battery was changed two weeks ago. I'm still not paying out of pocket.

I see so many people whining about American medicine. I think its great.

 

So you are suggesting that health insurance companies [some of the largest corporations in the world] had no effect on how this health care system evolved? I am sure the AHA had its share of influence, but to discount the influence of the insurance companies would be silly. The point is that the insurance model which was adopted created the runaway costs which have plagued the system for decades. Health insurance essentially became an indirect tax on society at all kinds of levels. And who exactly is deciding how much the American people can afford to pay?

If you believe you can continue to invest a nearly unlimited amount of money into health care technology and have it be affordable, I am not sure how you are arriving at such a conclusion. Anything close to free market capitalism cannot exist in the midst of BIG government and BIG corporations. Both need to exit.

And if you wish to continue this conversation, please desist from the juvenile comments. Thanks.

 

The bankers on Wall Street can't understand why people complain either. Imagine people making less than mid six figures! Light weights.

 

Really? Does getting the government and corporations out of health care sound like what's going on in Europe?

Look, among the biggest issues in health care is that our practice model was taken over by insurance companies. If you cannot control the care you give to your patients, it's pretty much a done deal. This has been accomplished over the past decades by a coalition of government bureaucrats and corporations that decided how, what, and when...and then make the provider responsible.

It's a horrendous system...and one doing EXACTLY what it was designed to do...provide government control and while maximizing corporate profits.

 

First the government issues and enforces patent, professional licensing, and other monopolies that make the price of medical treatments 5-10x (even 100x!) their production cost. Then it tells you to pay for your own medical care in the "free market."

 

In this case, the takers, slackers and parasites are the medical rentiers, especially pharma corporations.

 

If you work successfully for many years, manage your money and your investments intelligently, and are able to retire eventually and then live on the 'fruit of your labor', how is that a bad thing? .That is, after all, what most in the "rentier" class do... or do you think that a person should simply toil all his or her life and have nothing but an impoverished retirement to look forward to?

Returning (again) to the thread topic, I suggest that a single-payer system could work, and it could work very well -- BUT -- in order for it to work, everyone who enrolls must PAY INTO THE SYSTEM. It should not, and must not turn into a big socialist 'quagmire' of people who enroll for full-tilt benefits, but pay NOTHING to be a part of the biggest customer-base in the world, capable of negotiating the very best terms and conditions for healthcare in this same world!

 

It's a bad thing when what you have been "working successfully at" is not productive labor that relieves scarcity, but merely getting something for nothing by being legally entitled to abrogate others' rights without making just compensation. If someone works successfully for many years, manages their money and their investments intelligently, and then buys some slaves to live off their fruit of their labor, is that a bad thing? The only difference between owning slaves and owning rentier privileges is that when you own a slave, you own all of one person's rights, whereas when you own a privilege, you own one of all people's rights.

Just as slave owners did. Right.

Try to understand: any "argument" that could be used to justify chattel slavery, such as your argument above, is already known in advance to be fallacious, dishonest, and evil, with no further argumentation needed.

That is what the privileged do to the productive. Hello?

There is a difference between working successfully at productive labor to relieve scarcity and working successfully to legally transfer scarcity from oneself to others.

Nonsense. Some people can't pay.

You evidently do not know what "socialist" means. Everyone "pays" to be a member of the community by relinquishing their liberty to do as they please and undertaking to respect others' rights.

 

No, the insurance model was made necessary by the runaway costs created by monopoly privilege. People only need insurance because without it, illness is a financial death sentence.

It's not a tax because greedy, privileged, private interests get the money, not government.

Those who enjoy the government-issued and -enforced monopoly rentier privileges.

The money is not unlimited, and is mostly being invested by governments anyway. Private medical corporations spend far more on marketing than they do on research. That is inherent in the monopoly privilege model.

There is no such thing as free market capitalism because it is a logical contradiction. Capitalism by definition requires private ownership of the means of production: producer goods and natural resources. But private ownership of natural resources forces everyone else to subsidize the resource owners. Forced subsidies cannot exist in a free market. QED.

It's not the size of government or corporations that is the problem. It's the institutional environment that makes them harmful to the community whatever their size.

 

Congratulations.

But understand: you are still paying.

That's a hard claim to justify, given that it is by far the most expensive health care in the world, yet also far from the best as measured by health outcomes.

 

Can’t say I disagree with anything @impermanence has said. Hats off to a very well thought out OP

 

That's not the way it started. Initially, health insurance was quite reasonable. As more money was pumped into the entire health care establishment, costs began to go up and up and up...and amazingly, none of the interests who were making money hand over fist had any problem with this.

At the same time, the American people were convinced that they should live forever no matter how they conducted their lives, so they began to adopt horrendous lifestyle habits thinking that the health care system would eventually bail them out. And here we are decades later living out this hell.

 

True, the rent seeking has become an order of magnitude worse, and insurance is probably keeping people from realizing just how bad it is, and doing something about it.

Right. But without the monopolies, the market would increase supply enough to bring prices down, as profit-seeking is supposed to do in a free market.

But that makes no sense, because people in other advanced countries, whose health care systems do bail them out, nevertheless have healthier lifestyles.

 

Why do you presuppose that free-market capitalism necessarily requires the 'enslavement' of one group of people by any other group? Your assumption is especially inapplicable in the U. S., which banned slavery completely 158 years ago! Can you at least agree that as free American citizens, we are free to pursue any lawful enterprise or any legal career path we choose? Some of your other assumptions about what is "productive" and what is not are highly subjective and not supported in your hypothesis at all. Don't you see? Each of us decides what is "productive" for ourselves, and congenial with our individual interests and our goals. Want to be a brain-surgeon, or maybe a ditch-digger? Go for it! It's all up to the free, individual citizen to decide what he or she wants to do!

Now, in something as universally-applicable as healthcare for the nation's citizens, however, there is justification for the formation of an enormous "customer-base" of single-payer system enrollees who are able to negotiate the best terms, conditions, and prices (and in pharmaceutical drugs, too). Everyone who is a part of this nationwide "buyers-club" MUST PAY INTO THE SYSTEM in order for it to work at all!

BUT, you're right in observing "Some people can't pay"; and for that reason, we will be forced to keep an auxiliary 'charity' healthcare system -- and we already have one... it's called MEDICAID! In 2021 alone, United States taxpayers spent a staggering $734,000,000,000 on Medicaid! And, sure, even with a single-payer system, taxpayers will have to go on paying for those who won't/don't/can't pay their own "fair share".

 

There can never be such a thing as free market capitalism because it is a contradiction in terms. Proof: By definition, capitalism requires private ownership of the means of production: producer goods and natural resources. But private ownership of natural resources forces everyone else to subsidize the owners. Forced subsidies cannot exist in a free market. Therefore, there can never be such a thing as free market capitalism. QED.

See above. All people have a natural individual liberty right to use natural resources to sustain themselves. Capitalism forcibly removes that liberty right and converts it into the private property of the resource owners. Making people's individual rights to liberty into other people's private property is enslavement.

Did it? Read and learn:

"During the war I served in a Kentucky regiment in the Federal army. When the war broke out, my father owned sixty slaves. I had not been back to my old Kentucky home for years until a short time ago, when I was met by one of my father's old negroes, who said to me: 'Master George, you say you set us free; but before God, I'm worse off than when I belonged to your father.' The planters, on the other hand, are contented with the change. They say, ' How foolish it was in us to go to war for slavery. We get labor cheaper now than when we owned the slaves.' How do they get it cheaper? Why, in the shape of rents they take more of the labor of the negro than they could under slavery, for then they were compelled to return him sufficient food, clothing and medical attendance to keep him well, and were compelled by conscience and public opinion, as well as by law, to keep him when he could no longer work. Now their interest and responsibility cease when they have got all the work out of him they can."
From a letter by George M. Jackson, St. Louis. Dated August 15, 1885. Reprinted in Social Problems, by Henry George.

Are you starting to get the picture? If you think landowning is not like slavery, then why did African American slaves in the antebellum South have better diets, better housing, better health, and a longer life expectancy than contemporaneous landless European peasants? The fact that emancipation did not perceptibly improve the material condition of the vast majority of "freed" slaves was a mystery that was widely remarked at the time.

You need to stop typing and start thinking.

"Free"? Free to pay the privileged for their permission to exercise your right to liberty, you mean...?

Lawful. There's the rub. It was also lawful for slave owners to whip their slaves to make them work.

No they aren't. By definition, productive labor relieves scarcity. That is what makes it different from stealing and rent seeking.

False. See above and try to find a willingness to know the relevant facts.

No, that is just objectively false. A thief's labor in planning and executing a heist does not become productive through being congenial to his individual interests and goals, any more than rent seeking behavior or forcing slaves to work without wages become productive through being legal.

GET IT???

Brain surgery and ditch digging both relieve scarcity. Slave owning, landowning, patent trolling, etc. do not.

Health care, like education, public security, national defense, etc., is a market failure situation for reasons that are well understood by economists.

No, because some people can't pay. While there is no right to health care, it is a serious market failure, and prudent public policy makes it available to all in the public interest. If people want more than the care that is available to all, of course they should be free to pay for it themselves, either directly or via insurance.

Which was about an order of magnitude more than it would have been without the monopoly privileges.

One universal single-payer system is better than a tiered system for the same reasons UBI is better than means-tested welfare systems.